Is Dementia Care Covered by Medicare?

Having health insurance can help you pay for fees associated with medical care and different insurance plans cover different services.  Check your plan and determine if Dementia care is included.  Medicare and Medicare Advantage insurance plans pay for some of the costs associated with memory care however the co-insurance, co-pays, and deductibles vary. Diagnostic and treatment services can include but are not limited to, cognitive skills testing, home health aides, medication, memory care assisted living, nursing homes, and hospice care.  In this article, we will review some policy coverage details and provide you with guidance and knowledge so you can be prepared.

First, we will define the terms used frequently for those that are unfamiliar with them.  A deductible is an amount of money that a person must spend within a specified time before the insurance will pay for a percentage of care.  This is a yearly deductible and will reset on January 1st of every year that you are insured.  Co-insurance is the part of cost that the insured is responsible for.  If you have Medicare Part B, you are responsible for twenty percent after you have satisfied your deductible.  This amount or percentage will differ from insurance plan to insurance plan.  When you have a co-pay, this means that you pay your percentage, 20% in our example, of the insurance company’s pre-determined cost for services and treatments that you receive.  You will recognize this when you pay for an office visit to a specialist or when you pick up prescription medicines.  The co-pay is the same amount for your medication unless they raise the price at the beginning of the year.

Medicare has four different parts, A, B, C and D, that seniors can qualify for.Medicare has four different parts, A, B, C and D, that seniors can qualify for.  It also has MediGap.  Each part helps pay for certain services and treatments.  Part A will pay for home healthcare, hospice care and nursing home care.  Part B will pay for preventative services like wellness check-ups, doctor appointments, necessary medical tests and or certain medical equipment.  Part C is comprised of Parts A and B plus coverage for your medicine and transportation to doctor’s appointments.  Part D is what covers your prescriptions.   MediGap is a supplemental insurance that covers your deductibles, co-pays and co-insurance fees that Part A and B don’t cover.

When your loved one is diagnosed with dementia, they and you will understandably have a lot of questions.  The most frequently asked question is, “What is dementia?”  Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life. Alzheimer’s is the most common cause of dementia accounting for 60-80% of cases according to the Alzheimer’s Association (www.alz.org).  A person will experience difficulty with short-term memory, communicating or finding words, visual and spatial abilities such as getting lost while driving, losing a wallet, difficulty reasoning or problem-solving, handling complex tasks, planning and preparing meals just to name a few.  Dementia and its symptoms are progressive, which means that the symptoms start slowly and gradually worsen.  Personalities often change because this illness affects emotions. Most common changes are increased anger and frustration but symptoms vary from person to person. Different types of dementia are associated with different types of cellular damage in particular regions of the brain. Although dementia is not a normal part of the aging process, the fact is that almost half of the elderly population over the age of 85 will have develop or already have some type of dementia or Alzheimer’s disease.

In early stages of dementia, Part A will pay up to 35 hours per week of home healthcare if your loved one is deemed home bound.  In later stages of dementia, your loved one will most likely need around the clock care.  Part A will pay for the first 100 days in a facility.  The co-insurance for those 100 days is as follows:  for day one to day twenty, there is no payment.  For days 21 through day 100, the payment is $161 a day.  Part B covers the testing, appointments and medical equipment necessary.  In early stages of dementia, there is a 20% co-insurance after a $198.00 deductible is met.  If your loved has less than six months to live, Medicare will cover hospice care for them.

Medicare Parts C and D are beneficial to have.  Part C will cover your transportation to doctor’s appointments if you are unable to get there on your own.  There are however deductibles and co-pays that vary from plan to plan.  Your plan provider can give you the exact costs associated with this service.  Part D covers the costs of your prescriptions.  Some are medicines are fully covered while others have a co-pay.  These also vary from plan to plan.  The best way to save money is to fill your prescriptions at an in-network pharmacy or mail order pharmacy and request your physician to give you a 90-day supply.

Medicare covers many services associated with dementia care.  Unfortunately, it does not cover everything.  Services not covered under Medicare for dementia care include: 24-hour home care, home delivered meals, after 100 days in a nursing facility, daycare for adults, vitamins, personal care, incontinence supplies and other home care needs like shopping and laundry.

Routine checkups or Wellness visits are an important part of care for the elderly.Routine checkups or Wellness visits are an important part of care for the elderly.  It is important to see the doctor for checkups so you, the doctor and your loved one can go over their daily activities, diet and exercise routines as well as discuss anything that is out of the ordinary.  Wellness visits are covered by Medicare and if they have Part B for more than one year, they are eligible for a wellness visit once every year.  No deductible or co-pay applies for the visit.  These visits are important so they can monitor, test and determine if your loved one is suffering from any form of dementia or Alzheimer’s.

So, how do you pay for memory care when the 100-day nursing home care has been exhausted and your loved one needs the assistance of a specialized memory care facility?  This question is often asked with fear and concern but needs to be addressed.  The result for many is that care has to be paid for with personal funds, whether yours or your loved ones’.  You do have options to consider such as a Life settlement which means selling a life insurance policy for a lump-sum cash payout and use the money however you choose, including memory care assisted living. If your loved one has a life insurance policy, the value of the policy could ensure their comfort and care.  MRE Finance specializes in helping seniors live out their life with dignity and comfort during trying times.  Find out the potential value of the life insurance policy by using our free estimate life settlement calculator mrefinance.com/get-a-free-estimate/

Our expert specialists will guide you through the process and the result is with the payout, your loved one will be cared for with the specialty assistance they need at the location of your choice.

Related articles